[A woman with hyperpigmentation and dark urine]

A 54-year-old patient was evaluated because of fever shortly after she had started treatment of a BRAF-mutated melanoma with BRAF- and MEK-inhibitors. Diffuse hyperpigmentation of the skin was noted as an incidental finding. She also had darkly coloured urine. This hyperpigmentation was most likely the result of diffuse cutaneous melanosis secondary to advanced melanoma. This complication results from the release of melanin or its precursor molecules into the systemic circulation. Although diffuse cutaneous melanosis is commonly regarded as an ominous prognostic sign, this patient has so far responded well to targeted therapy.